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Abstract
Background This territory-wide cohort study examined and compared the secular trends of glycemic control in cirrhotic and non-cirrhotic patients with type 2 diabetes mellitus (T2DM) in Hong Kong.
Methods This retrospective study included T2DM patients with or without cirrhosis between January 2000 and December 2023 in Hong Kong after excluding patients who had missing demographic data, aged <18 years at diagnosis, and had type 1 diabetes mellitus. The study period was separated into 2000-2004, 2005-2009, 2010-2014, 2015-2019, and 2020-2023. Serial laboratory measurements in each period were summarized by time-weighted average. The percentage of patients with and without cirrhosis who achieved time-weighted average fasting blood glucose <7.2mmol/L and average hemoglobin A1c (HbA1c) <7% were compared.
Results Of 1,206,233 patients with T2DM from 2000 to 2023, 63,200 (5.3%) (mean age 63.1 years, 52.0% male) had cirrhosis. Between the periods 2000-2004 and 2020-2023, the time-weighted average HbA1c of cirrhotic patients decreased from 7.5% (SD 1.7) to 6.5% (1.2), while that of non-cirrhotic patients decreased from 7.6% (1.5) to 6.9% (1.0) (change in cirrhotics vs non-cirrhotics; P < 0.001). Similarly, fasting blood glucose dropped from 8.1 (2.8) mmol/L to 6.9 (2.1) mmol/L in patients with cirrhosis, compared with 8.1 (2.5) mmol/L to 7.1 (1.8) mmol/L for those without cirrhosis (P < 0.001). The percentage of cirrhotic patients with HbA1c <7% increased from 44.3% to 76.0%, while the percentage of non-cirrhotic patients with HbA1c <7% rose from 40.1% to 66.6%. Similarly, the percentage of patients whose fasting glucose levels <7.2mmol/L increased from 40.9% to 65.8% for cirrhotic patients, and from 39.5% to 63.4% for non-cirrhotic patients (IDDF2024-ABS-0348 Figure 1).
Conclusions Control of fasting blood glucose and HbA1c improved over time in patients with T2DM regardless of the presence of cirrhosis. The magnitude of the decreasing trend is more prominent among cirrhotic patients.
